Well guys,as jeoprady is ongoing,we must take the challenge against every form of NBME withstrong conviction. This post will be accumulation of all the questions that I think thats hard or tricky.So the prize here is that you will ALL do well on real USMLE. The people who are struggling, or the people who keep thinking they CAN'T do it, we must bring them out and make them rise.
That is the beauty of this forum, we must push each other even if we do not know each other.
We are doing this for the love of medicine together.

Who will be in this boat with me? I don't know if I can gear this boat by myself, if I do I might be lost guys, so help each other like we all are doing now.

A 46-year-old obese woman has had symptoms of vulvovaginitis for the past 9 months that is found to be caused by Candida. Laboratory tests reveal proteinuria and glucosuria, and increased BUN and creatinine. If a renal biopsy were performed, which of the following would be the most likely findings in the glomeruli?

1.) A 45-year-old man develops a fever, a cough productive of rusty sputum, and chest pain. Sputum cultures are positive for Streptococcus pneumoniae. He is treated with antibiotics and recovers uneventfully. Which of the following cell types is most likely responsible for regeneration of the injured tissue?

A) Clara cell

B) Fibroblast

C) Macrophage

D) Type I pneumocyte

E) Type II pneumocytes +++

Two types of cells contribute to the maintenance of the alveoli of the lungs: Type I and Type II pneumocytes. These cells function to aid in gas exchange, secretion of pulmonary surfactant, and self-regeneration.Type I pneumocytes are responsible for gas exchange in the alveoli and cover a majority of the alveolar surface area (>95%). While type I pneumocytes account for most of the surface area, they are approximately half as numerous as type II cells, due to differences in size. Type I pneumocytes are large, thin cells stretched across a large surface area, while type II pneumocytes are smaller cells.Type II pneumocytes are granular and roughly cuboidal in shape. Type II pneumocytes are typically found at the alveolar-septal junction and cover a much smaller surface area than type I cells (

2.)An otherwise healthy 80 year old man is scheduled for endoscopy for evaluation of rectal bleeding. A standard dose of midazolam is administered intravenously when the patient is admitted to the endoscopy suite. A few minutes later, he develops cyanosis and labored respirations and requires ventilation with an oxygenated resuscitation bag. An age-related increase in which of the following is the most likely cause of these adverse effects?

the ans is D, increased sensitivity to sedatives in elderly. WELL I THINK HE IS HAVING A LIVER CIRRHOSIS ISSUES HENCE THE HEMMOROIDS FORMATION, BENZOS ARE METABOLIZED IN THE LIVER, SO IF THE LIVER IS SHOT,THEN YOU WILL HAVE INCREASE LEVELS OF BENZO'S IN THE BLOODSTREAM, AND YOU DO NOT WANT TOO MUCH OF THIS FLOATING IN THE BLOOD.

3.)A 65-year-old man with inguinal adenopathy undergoes a lymph node biopsy. Light microscopy shows replacement of nodal tissue by cells that form well-defined, uniform glandular structures. The nuclei are relatively small and nucleoli are inconspicuous. An immunohistochemical stain for prostate-specific antigen is positive. These findings are most consistent with which of the following?

Lymph node mets -- high stage
micro fo LN well defined sts -- low grade
THE CANCER WENT TO THE LYMPH NODE SO IT MUST BE HIGH STAGE NEOPLASM
BUT IN THE LYMPH NODE IT SHOWS WELL-DEFINED,UNIFORM GLANDULAR STRUCTURES
SO ITS LOW-GRADE.

3.)A 3-year-old boy has a 5-week history of weight loss and bulky, frothy, foul-smelling stools. Dietary modification results in clinical improvement. Which of the following is the most likely finding on examination of a biopsy specimen from the small intestine?

YOUNG KID,CELIAC SPRUE IS MOST LIKELY TO OCCUR IN YOUNG KIDS,VILLI OF THE BRUSH BORDERS ARE FLATTENED THUS ABSORPSTION IS DECREASED AND YOU GONNA
HAVE REALLY STINKY STOOLS SO HAVE A NOSE MASK! OR HAVE ALOT OF FLOWERS WITH SCENT AROUND :)

4.)A 3-year-old boy with cystic fibrosis is evaluated for the acute onset of an uncontrollable nosebleed. There is no family history of a bleeding disorder. A few large bruises are seen on the legs; no other abnormalities are noted. Prothrombin and partial thromboplastin times are prolonged. The patient's abnormalities are likely to improve with treatment using a cofactor for which process?

6.)A 45-year-old woman who has acute diverticulitis develops severe hypotension, tachypnea, and tachycardia. She subsequently develops cyanosis and hypoxemia unresponsive to oxygen therapy. X-ray films of the chest show a diffuse alveolar infiltrate. Blood culture grows Escherichia coli. A major factor in the pathogenesis of this syndrome is
A) degranulation of mast cells
B) delayed (type IV) hypersensitivity to bacterial products
C) increased surfactant production by type II pneumocytes
D) production of antibodies to alveolar basement membranes
E) release of oxygen free radicals from sequestered neutrophils

DIVERTICULITIES-WEAKENS IMMUNITY,BASICALLY AN IMMUNE ATTACK ON YOUSELF,MORE
PRONE TO GET AN INFECTION SO HERE E COLI IS THE VICTIM! SEPTIC SHOCK(HYPOTENSION,TACH) E IS THE BEST ANSWER, BUT CYTOKINES IS A BETTER ANSWER I WOULD OF LIKED.

7.)Basic fibroblast growth factor is applied to an experimentally induced dermal wound. A histologic section is prepared 72 hours later. Compared with an untreated wound, the most likely alteration in this wound is

8.) A 29-year-old patient has a 3-week history of persistent cough and intermittent flushing and diarrhea. An x-ray film of the chest and bronchoscopy show a 2-cm, solitary, well-defined mass that projects into the lumen of the mainstem bronchus. The mucosa of the bronchus is intact. These findings are most characteristic of

9.)A 56-year-old man with extensive coronary artery atherosclerotic disease has evidence of coronary vasoconstriction and myocardial ischemia. The most likely cause of the vasoconstriction is failure of the endothelial cell layer of the diseased coronary arteries to produce a substance with which of the following actions?

A) Activation of Na+ channels

B) Closure of K+ channels

C) Opening L-type Ca2+ channels

D) Stimulation of ATP accumulation

E) Stimulation of cyclic GMP accumulation

****NO IS NOT BEING RELEASED,FROM ARGINE.**** E IS THE ANSWER

10.)A 61-year-old woman has a 10-year history of progressive pain in the hips, knees, and hands. She has symmetric swelling and formation of nodules in the distal interphalangeal joints of her hands and pain on movement of both knees. There is no increased warmth or tenderness. The most likely cause of her joint pain is

11.)A 38-year-old woman has noticed the gradual development of a goiter. Thyroid function studies show serum thyroxine (T4) and triiodothyronine (T3) concentrations to be within the reference range. Serum concentration of thyroid-stimulating hormone is slightly increased. The serum contains a high level of antimicrosomal (antiperoxidase) antibodies, but no thyroid-stimulating hormone receptor antibodies are detected. The most likely diagnosis is

E. SODIUM ACCUMULATION BRINGS A FLOOD INTO THE CELL! Na/ATP ase function lost from lack of ATP due to hypoxia. BLOOD FLOW IS LACKING WHICH BRINGS O2 RIGHT,
SO NO O2,SO MITO WON'T FUNCTION PROPERLY HENSE LESS PRODUCTION OF ATP :(

13.)A 20-year-old man has a painless 2-cm nodule in his right scrotum. The nodule is difficult to distinguish from the right testis and does not transilluminate. There is no additional swelling or inguinal adenopathy. The most likely diagnosis is

right testis and does not transilluminate TELLING US ITS NOT HYDROCELE.ITS NOT A, IF IT WAS THEN YOU WOULD FEEL LUMP AROUND THE INGUINAL AREA. NODULE-INDICATING
ITS A TESTICULAR CANCER. D is answer

14. A 50-year-old woman comes to the physician because of a fever, cachexia, and malaise for the past 6 months. Auscultation discloses a low-pitched, early to mid-diastolic murmur. Echocardiography shows a left atrial mass that prolapses into the mitral valve orifice during diastole. Which of the following findings is most likely on microscopic examination of this mass?

A) Amorphous extracellular matrix

B) Glycogen-containing polygonal cells

C) Malignant lymphoid cells

D) Malignant spindle cells

E) Mature adipose cells

B IS THE ANSWER. MYXOMA-TUMMOR OF THE CONNECTIVE TISSUE FILLED WITH MUCUS.The cells that make up the tumor are (spindle-shaped cells-dont forget this,maybe they can be CRUEL AND PUT THIS!) and are embedded in a matrix rich in mucopolysaccharides (a group of carbohydrates(THAT IS WHY ITS GLYCOGEN(BC GLYCOGEN IS MADE OF CARBS ISN'T IT!).

15.A 38-year-old man comes to the physician because of involuntary movements of the arms and legs for the past month and progressive facial twitching and grimacing over the past year. Neurologic examination shows athetoid and choreiform movements of the arms and legs, dystonic movements of the tongue, dysarthria, impairment in immediate and short-term memory, and dyscalculia. Which of the following is the most likely diagnosis?

C. HUNTINGTONS LIKES TO DO THE BOOGIE WIGGIE.CAUDATE NUCLEUS IS DAMAGED,
SO EVEN THEY CAN CHANGE THIS QUESTION AROUND AND POINT TO A PICTURE AND ASK WHERE IS THE DAMAGE OCCURING NEAR THE LATERAL VENTRICLES!

POTASSIAM IS THE CULPRIT HERE. D IS THE ONLY ONE THAT MAKES SENSE TO ME.
SOMEONE FURTHER EXPLAIN THIS THANKS

17. An afebrile 8-year-old girl is evaluated for mild edema and a "puffy" face. She recovered from an untreated sore throat and fever 3 weeks ago. Urinalysis shows moderate proteinuria and hematuria with occasional red cell casts. A photomicrograph of renal tissue obtained on biopsy is shown. Which of the following is most likely responsible for the cellular infiltrate shown?

A) Bradykinin

B) C5a

C) Histamine

D) N-formylated peptides

E) Serotonin

COMMON QUESTION WITH THIS PHARGYNITIES POINT! IT CAN HIT YOU TO THE HEART-RHEUMATIC FEVER OR IF IT WANTS HIT YOU AT THE KIDNEYS! VICIOUS LITTLE CREATURE!
HOW DO YOU PREVENT THIS INFECTION,AMOXCILLIN?.TYPE II HYPERSENSITIVITY! For PSAGN, the evidence suggests that immune complexes, preformed by the combination of specific antibodies against streptococcal antigens, localize on the glomerular capillary wall and activate the complement system. The immunologic system may also be activated by streptococcal antigens that adhere to the glomerular structures(SORT OF LIKE PLOTTING A TERROR SCENE IN YOUR BODY GRRRR!!!!!!!!!) and act as "planted antigens" or by alterations in endogenous antigens. The activation of the complement cascade then generates chemotactic plasma-activated complement 5 (C5a) and platelet-derived inflammatory mediators. Various cytokines and other cellular immunity factors initiate an inflammatory response manifested by cellular proliferation and edema of the glomerular tuft.

18. A 45-year-old man who is undergoing dialysis for chronic renal failure starts receiving erythropoietin therapy. He has a history of type 1 diabetes mellitus, peripheral neuropathy, and well-controlled hypertension. Exacerbation of which of the following is most likely to occur in this patient?

A) Chronic renal insufficiency

B) Diabetes mellitus

C) Hypertension

D) Osteitis fibrosa cystica

E) Peripheral neuropathy

CCC: ERYTHROPETIN STIMULATES PRODUCTION OF RBC'S

19. A 21-year-old woman comes to the physician because of a vaginal discharge for the past 2 weeks. She has had 3 sexual partners in the past 6 months. Examination shows tenderness with cervical motion. The discharge is mucopurulent and the cervical os is erythematous and edematous. This patient is at greatest risk for the development of which of the following?

D is the answer
PID- infertile,BC YOU ARE SCARRING THE FALLOPIAN TUBES COMON LADIES!

20. A 45-year-old woman has a 3-month history of a persistent cough and increasing shortness of breath. She denies chest pain or other illnesses. Blood pressure is 110/70 mm Hg, and pulse is 110/min. She has diffuse basilar crackles and an S3 gallop, but no murmur. ECG shows sinus tachycardia and nonspecific ST-T wave changes. Echocardiography shows a dilated left ventricle and a diffusely hypokinetic heart. The most likely diagnosis is

ANSWER IS IN THE PASSAGE HAHA B!
21.
An elderly woman has had generalized bone pain and a loss of height over the last 5 years. Complete blood count is normal. Serum calcium, phosphate, and creatinine concentrations and serum alkaline phosphatase activity are within the reference range. Serum protein electrophoresis shows no abnormalities. X-ray films of the spine show generalized loss of bone density and a compression fracture of T-8. Which of the following is most likely to be seen in tissue obtained on biopsy of the iliac crest?
A) Cysts filled with fibroblasts and giant cells
B) Disorderly osteoblastic and osteoclastic activity
C) Sheets of plasma cells
D) Thin trabeculae with low osteoclastic activity

OSTEOPOROSIS. THIS YOU CAN NARROW IT DOWN TO B OR D.
BUT D IS BETTER BC THE TRABECULAE IS THINNED!I THINK IN OSTEOPOROSIS
THE REMODELING PROCESS IS SLOW. PLUS ELDERLY WOMEN ARE MOST OF THE TIME
LACKING ESTROGEN WHICH IS A BIG HELP IN BONE FORMATION.

22.A healthy 25-year-old woman who is at 24 weeks' gestation develops heartburn within an hour after eating. Which of the following is the most likely cause?
A) Decreased competency of the lower esophageal sphincter
B) Decreased esophageal motility
C) Increased gastric acid production
D) Increased gastric emptying
E) Increased gastric motility

A.THAT IS WHAT HEARTBURN IS. JUST A DEFINITION TYPE OF QUESTION. DO YOU KNOW
THE MEANING OF HEARTBURN THATS ALL!

23.A 5-month-old male infant develops lethargy, somnolence, hypothermia, feeding problems, and persistent jaundice. After several days, he develops a hoarse cry and hypotonic muscles. The tongue is large and protruding, and an umbilical hernia is noted. Hematologic evaluation shows no abnormalities. Which of the following abnormalities is most consistent with these findings?

24. Over a period of 3 weeks, a 60-year-old woman develops anorexia, restlessness, irritability, and confusion. Serum sodium concentration is 125 mEq/L; urine osmolality is increased. Assuming the patient's disorder represents a paraneoplastic syndrome, which of the following diagnostic procedures is most likely to result in an abnormal finding?

A VERY NICE THINKING QUESTION I LIKE.
SIADH FROM SMALL-CELL CARCINOMA OF THE LUNG: E
IT CAN PRODUCE CUSHIN SYNDROME TOO! MOON MAN OR GIRL YOU CAN SEE THERE.

25.A 16-year-old boy is brought to the emergency department because of respiratory distress. Examination shows a large mediastinal mass and 3-cm firm cervical lymph nodes bilaterally. Examination of tissue obtained on cervical lymph node biopsy shows small lymphocytes interspersed with binucleate cells with clear chromatin and large eosinophilic nucleoli. The most likely diagnosis is

memorization question again! STEP LIKES TO BE A LITTLE TOUGH AND WON'T GIVE CATCHY WORDS ALWAYS. SO KNOW THE REAL DEAL GUYS.
D and the binucleate cells are reidsternberg cells

26.
An 83-year-old woman dies after having progressive memory loss, apraxia, and aphasia for 4 years. A photomicrograph of brain tissue obtained on autopsy is shown. Which of the following is the most likely cause of these findings?

2.)An otherwise healthy 80 year old man is scheduled for endoscopy for evaluation of rectal bleeding. A standard dose of midazolam is administered intravenously when the patient is admitted to the endoscopy suite. A few minutes later, he develops cyanosis and labored respirations and requires ventilation with an oxygenated resuscitation bag. An age-related increase in which of the following is the most likely cause of these adverse effects?

the ans is D, increased sensitivity to sedatives in elderly. WELL I THINK HE IS HAVING A LIVER CIRRHOSIS ISSUES HENCE THE HEMMOROIDS FORMATION, BENZOS ARE METABOLIZED IN THE LIVER, SO IF THE LIVER IS SHOT,THEN YOU WILL HAVE INCREASE LEVELS OF BENZO'S IN THE BLOODSTREAM, AND YOU DO NOT WANT TOO MUCH OF THIS FLOATING IN THE BLOOD.